With debts so massive, any financial missteps or career miscalculations can have significant,
lifelong consequences.

Lawyers and health-care professionals carry the largest student-debt loads in the country. But
doctors, pharmacists, dentists and others working in medical fields face additional government
sanctions if they default on loans made by the U.S. Department of Health and Human Services.

The government can suspend or revoke their licen-

ses to practice, and it can prevent them from working in a facility that receives money from the
Medicare and Medicaid programs or from seeking reimbursements from the federal health programs for
the elderly and the poor.

“Preventing renewal of a professional license is one of the most counterproductive penalties for
defaulting on a federal education loan. How is a borrower to repay the defaulted loan if they can’t
work?” said Mark Kantrowitz, a financial-aid expert and publisher of Fin-

Aid.org and FastWeb.com. “A doctor or lawyer who can’t work in the field for which they trained
will not ever be able to repay the debt they incurred for that education.”

Today, more than 2,300 health-care professionals are excluded from the Medicare and Medicaid
programs because they defaulted on their federal student loans.

In 1993, the federal government began publicly shaming doctors, dentists and pharmacists who
failed to repay their student loans by including them on the publicly available Medicare Exclusions
List.

The list also includes health-care professionals who defrauded the programs or committed
crimes.

Among the student-loan defaulters on the list are a Cleveland-area podiatrist who died eight
years ago and six other Ohioans who have been excluded for

20 years.

Although medical professionals tend to earn six-figure salaries, many graduate with a mountain
of debt and begin their careers with lower incomes.

A May 2009 report by the U.S. Government Accountability Office found that the median amount of
educational debt for medical students graduating in 2008 was $155,000 — a 53 percent increase since
1998, controlling for inflation.

Once out of medical school, residents earn a gross salary of about $3,729 a month. With $155,000
in debt, a resident’s monthly loan payment could reach more than $1,700 and eat up nearly half of
his or her pre-tax income.

Nearly 50 percent of medical students who graduated in 2008 had at least $150,000 in outstanding
student loans.

One physician who joined the military said his government pay was so low that he requested and
received forbearance for his $60,000 in student loans until he earned a higher salary. The
interest, however, continued to accrue, so that at the end of the grace period, the loan had
ballooned to $110,000.

“I have served with the Special Forces and put myself in dangerous situations for my country
multiple times. I have served three combat tours. Yet, I am enslaved by my student debt,” he wrote
to the consumer watchdog agency.

A dentist from California complained that he now owes $333,324 on the $101,360 in loans he took
out a quarter-century ago.

The dentist, who asked not to be identified because of pending legal matters tied to the loans,
said the debt has mushroomed despite having paid $45,000 more than he originally borrowed.

His loan troubles escalated mainly because the payments were too high, he said, and he barely
made enough money to live on after dental school. He admits making things worse by delaying
payments and consolidating the loans, which made his debts even bigger.

“Like a fatal disease, they have adversely affected everything I’ve done since about 1989,” he
said. “Everywhere I have turned, they have been stalking me, haranguing me, yet staying out of
reach of any solution — like a bully taunting and harassing, or like a genetic defect.”

That dentist, who attended the University of Southern California’s dental school, has been on
and off the exclusion lists throughout his career, his eligibility restored when he made payments
before defaulting time and again.

More than 70 percent of the health-care professionals on the list are chiropractors or
dentists.

The Dispatch contacted several medical professionals who are banned from receiving
reimbursements through Medicare and Medicaid. All declined to speak publicly because they said it
would hurt their practices if patients knew they had struggled with student loans.

Many said they just couldn’t earn enough after medical school to prevent loans from defaulting,
and it has taken them decades to dig their way out of the debt.

The public policy surrounding student debt for health-care professionals is partly to blame,
said David O’Bryon, executive director of the American Chiropractic Association.

Chiropractic students have been ineligible to receive subsidized government loans, so interest
accumulated while they were in school. They will not feel so alone in July, when the interest
subsidy will vanish for all students enrolled in graduate programs or above.

Chiropractors also have been banned from participating in programs that offer up to $50,000 in
loan forgiveness in exchange for working two years in a community-health center or in an area in
desperate need of health care.

“We need equal access into those programs,” O’Bryon said. “You have a social program to get
people into medically underserved areas. Chiropractors sometimes are the only caregivers in a small
community.”

Although the U.S. Department of Defense has chiropractors on its staff, they are not offered
entrance into loan-forgiveness programs offered by the federal government.

Lloyd, Ohio State’s dentistry dean, said the lack of a loan-forgiveness program also hampers
dentists. While there are some such programs, there are far too few to meet demand.

President Barack Obama’s health-care plan is silent on the issue. “No one’s talking about who’s
going to finance health education,” Lloyd said. Right now, “it’s shouldered by the individual
practitioner.”